Neupro (Rotigotine) - Transdermal

What Is Neupro?

Neupro (rotigotine) is a prescription transdermal patch applied to the skin to treat Parkinson's disease and restless leg syndrome in adults. It is in a drug class known as non-ergot dopamine agonists.

Rotigotine works by improving the symptoms of Parkinson's disease, including movement control. It acts as a natural chemical in the brain called dopamine, which acts as a messenger between nerves. This helps to control movement. People with Parkinson's disease may have low dopamine, making it difficult for these nerves to communicate with one another. Neupro mimics dopamine in the brain.

Rotigotine is a 24-hour skin patch designed to deliver the drug through the skin directly into the bloodstream.

Drug Facts

Generic Name: Rotigotine
Brand Name: Neupro
Drug Availability: Prescription
Administration Route: Transdermal
Therapeutic Classification: Antiparkinsonian
Available Generically: No
Controlled Substance: N/A
Active Ingredient: Rotigotine
Dosage Form(s): Extended-release patch

What Is Neupro Used For?

Neupro is a prescription drug used to treat both early-stage and advanced stages of Parkinson's disease. It also treats restless leg syndrome.

Since users wear a patch at all times (changing them every 24 hours), Neupro provides continuous drug delivery and keeps blood levels of the drug stable. This is associated with fewer motor fluctuations and uncontrolled muscle movements (dyskinesia) than dosing that is not continuous.

How to Use Neupro 

Neupro comes as transdermal patches that should be applied daily to the skin.

When using the patch, remember to:

  • Shave hair on the application site at least three days before applying the patch to it.
  • Wash your hands before and after use.
  • Inspect the patch (do not use it if it is cut or does not look right).
  • Apply patch to clean, dry, hairless uninjured skin once daily (every 24 hours).
  • Apply at the same time each day to the shoulder, hip, upper arm, stomach, or thigh.
  • Firmly press it down on your skin for 30 seconds.
  • Rotate the sites of application every day.

When using the patch, do not:

  • Apply to damaged, irritated, or oily skin
  • Apply where the patch may rub against tight clothes. 
  • Apply it to the same area more than once every 14 days. 
  • Stop using it suddenly. Your healthcare provider will need to gradually lower your dose before stopping it.

Be careful not to knock your patch off. If your patch is loose, use tape only on its edges to keep it in place. However, apply a new patch to your skin if your patch falls off.  

Fold the sticky sides of the used Neupro patch to each other before tossing it. Always wash the site with water and soap every time you remove it.

This patch contains metal like aluminum. Remove the patch before a medical test called magnetic resonance imaging (MRI) to avoid skin burns. Do not expose your patch to heat sources like an electric blanket, hot tub, heating pad, hair dryers, or direct sunlight.

Storage

Keep the patches in their original pouch until application. Store in a dry place at room temperature (between 68 F and 77 F). Do not store it in the bathroom. It's OK to temporarily keep Neupro patches in cold and mildly hot temperatures (59 F to 86 F).

You can throw used patches in the household trash, but ensure they are kept out of reach of children and pets to prevent accidental ingestion.

How Long Does Neupro Take to Work?

Once applied to the skin, it takes from four to 27 hours for your body to fully absorb the drug. Depending on how you respond to treatment, your healthcare provider may switch your dose until symptom control is achieved.

What Are the Side Effects of Neupro?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider or pharmacist. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

Tell your healthcare provider if any of these side effects or symptoms do not go away or become bothersome.

In Parkinson's disease, common side effects of Neupro include:

  • Nausea and vomiting
  • Drowsiness
  • Application site reaction
  • Loss of appetite (anorexia)
  • Sleep disturbances
  • Excessive sweating (hyperhidrosis)
  • Vision problems
  • Peripheral edema (swelling in the legs, ankles, feet, arms, or hands)
  • Dyskinesia (uncontrolled movements)

Common side effects of using Neupro for restless legs syndrome include:

  • Application site reaction
  • Nausea
  • Sleep problems
  • Drowsiness
  • Headache

Severe Side Effects

Contact your healthcare provider immediately if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Severe fatigue
  • Fast or abnormal heartbeat
  • Uncontrollable urges or compulsive behaviors (e.g., intense impulses to gamble, spend money, or binge eat)
  • Weight gain
  • Swelling (edema)
  • Severe dizziness
  • Trouble breathing
  • Vision changes
  • Severely stiff muscles or muscle pain
  • Hallucinations and other psychosis-like symptoms, like confusion
  • Abnormal movements
  • Severe headache
  • Chest pain
  • Fainting
  • Narcolepsy (sudden sleep attack)

Notably, the dose of this medication must be gradually decreased by a healthcare provider if you are planning on stopping treatment. Abruptly stopping it can cause withdrawal, with symptoms such as:

  • Hyperpexia (high body temperature above 106.7 F)
  • Confusion
  • Apathy (feeling a lack of interest or emotion)
  • Anxiety or depression
  • Trouble sleeping
  • Pain
  • Fatigue
  • Excessive sweating

Report Side Effects

Neupro may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much of Neupro Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For transdermal dosage form (patch):
    • For Parkinson's disease:
      • Adults—At first, one 2-milligram (mg) patch applied every 24 hours for early-stage disease or one 4-mg patch applied every 24 hours for advanced-stage disease. Your doctor will gradually increase your dose if needed and tolerated. However, the dose is usually not more than 6 to 8 mg every 24 hours.
      • Children—Use and dose must be determined by your doctor.
    • For Restless Legs Syndrome (RLS):
      • Adults—At first, one 1-milligram (mg) patch applied every 24 hours. Your doctor will gradually increase your dose if needed and tolerated. However, the dose is usually not more than 3 mg every 24 hours.
      • Children—Use and dose must be determined by your doctor.

Modifications

Your healthcare provider may make changes to your treatment plan based on the following:

  • Discontinuation: If you plan to stop treatment, your healthcare provider will gradually lower your dose to reduce the risk of withdrawal.
  • Pregnancy: There is not enough data to determine the safety of using Neupro during pregnancy. If you are pregnant or plan to become pregnant, work with your healthcare provider to decide whether you should continue to use this medication.
  • Breastfeeding: Neupro may affect the amount of milk you produce. Talk to your healthcare provider about the best steps to take if you are breastfeeding or plan to breastfeed while using Neupro.

Missed Dose

Apply the missed patch once you remember. If you forget to change your patch, remove the old patch as soon as you remember and replace it with a new one. Replace the patch at your normal time the next day.

Overdose: What Happens If I Use Too Much Neupro? 

Overdose symptoms may be related to excessive dopamine activity and include:

  • Nausea or vomiting
  • Severely low blood pressure
  • Involuntary movements
  • Hallucinations
  • Confusion
  • Convulsions

What Happens If I Overdose on Neupro?

If you think you or someone else may have overdosed on Neupro, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Neupro, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for unwanted effects.

This medicine may cause some people to become dizzy, drowsy, lightheaded, or faint. People using rotigotine have reported falling asleep without warning during activities of daily living, including driving, which sometimes resulted in accidents. This may happen as late as one year after taking the medicine. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert, well-coordinated, or able to think well. If these side effects are especially bothersome, check with your doctor.

This medicine may cause changes in your blood pressure or heart rate. Dizziness, lightheadedness, or fainting may occur, especially when you get up from a lying or sitting position suddenly. Getting up slowly may help. If the problem continues or gets worse, check with your doctor.

This medicine may cause some people to be agitated, irritable, or display other abnormal behaviors, including confusion, delusions, feeling aggressive or hostile, or seeing, hearing, or feeling things that are not there (hallucinations). If you or your caregiver notice any of these side effects, tell your doctor right away.

Some people who have used this medicine had unusual changes in their thoughts or behavior, including an urge to gamble, spend money, binge eat, or an increased sex drive. Talk with your doctor if this is a concern for you.

This medicine may cause fluid retention (edema) in some patients. Tell your doctor right away if you have bloating or swelling of the face, arms, hands, lower legs, or feet, tingling of the hands or feet, or unusual weight gain or loss.

Check with your doctor before using this medicine with alcohol or other medicines that affect the central nervous system (CNS). This medicine will add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of medicines that affect the CNS are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicines, medicine for depression, medicine for anxiety, prescription pain medicine or narcotics, medicine for attention deficit and hyperactivity disorder, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics.

The patch contains aluminum, which can cause skin burns when used during certain procedures such as magnetic resonance imaging (MRI) or cardioversion. To prevent skin burns, make sure the patch is removed before having these procedures.

Heat may cause too much of the rotigotine to pass through your skin. Do not expose the patch to direct sources of heat, such as heating pads, electric blankets, heat lamps, saunas, hot tubs, heated water beds, or direct sunlight. Direct sunlight may cause your skin to change color.

Tell your doctor if you develop a skin rash or irritation from the patch that lasts longer than a few days, becomes more severe, or spreads to areas outside the application site.

Do not change your dose or stop using this medicine suddenly without first asking your doctor. You will need to slowly decrease your dose before stopping it completely. Stopping this medicine suddenly may cause anxiety, confusion, depression, fever, lack of feeling or emotion, severe muscle stiffness, sweating, trouble sleeping, uncaring, or unusual tiredness or weakness.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn't Take Neupro? 

Avoid taking Neupro if you are hypersensitive to rotigotine or any part of its formulation.

What Other Medications Interact With Neupro?

Certain medications interact with Neupro, causing more side effects or lowering how well the drugs work.

Neupro should not be taken with another medication class known as dopamine antagonists or drugs with dopamine antagonist properties. Due to their opposing effects on dopamine, these kinds of medications may interfere with Neupro. These may include:

Additionally, some medications may increase sedative side effects when used with Neupro. These can include:

This is not a complete list of drug interactions, and others may occur. Before starting Neupro, tell your healthcare provider about all your prescription and over-the-counter (OTC) medications, vitamins, and herbal supplements.

What Medications Are Similar?

Other medications similar to Neupro include:

  • Gocovri (amantadine): Gocovri is another dopamine agonist used for Parkinson's disease. It is typically used to treat dyskinesia in those receiving levodopa-based therapy or as an add-on therapy for "off" episodes. However, this medication is taken orally.
  • Apokyn (apomorphine): Apokyn is used for the acute, intermittent treatment of "on" and "off" episodes in Parkinson's. It is administered through an injection.
  • Mirapex (pramipexole): Like Neupro, Mirapex can be used to treat Parkinson's and restless legs syndrome. It is available in tablet form to take orally.
  • Requip (ropinirole): Requip is a dopamine agonist for Parkinson's and restless leg syndrome. It is an oral medication available in tablet form.

This is a list of drugs also prescribed for Parkinson’s disease or restless leg syndrome. It is NOT a list of drugs recommended to take with Neupro. In fact, you should not take these drugs together. Talk to your pharmacist or a healthcare provider if you have questions.

Frequently Asked Questions

  • What is Neupro used to treat?

    Neupro is commonly used to improve symptoms of Parkinson’s disease. It is also used to treat restless leg syndrome.

  • What should I do if I forget to replace my Neupro patch?

    If you forget to change your patch, remove the old patch as soon as you remember and replace it with a new one. Replace the patch at your normal time the next day.

  • How long does it take for Neupro to work?

    Once applied to the skin, it takes from four to 27 hours for your body to fully absorb the drug. Your healthcare provider may then increase your dose until your symptoms are under control.

  • How should I store Neupro patches?

    Keep the patches in their original pouch until application. Do not store them outside of their pouches.

    Store them in a dry place at room temperature (between 68 F and 77 F). Do not keep it in the bathroom. It's OK to temporarily expose Neupro patches in cold and mildly hot temperatures (59 F to 86 F) for a short period, such as if you're traveling.

    When you're done with a patch, you can throw used ones in the trash. However, take care to make sure children or pets can't reach discarded patches.

  • What are some side effects of Neupro?

    Common side effects of Neupro may vary whether you're taking it for Parkinson's disease or restless leg syndrome. You may experience nausea or vomiting, drowsiness, sleeping difficulties, excessive sweating, and application site reactions, among others. Talk to your healthcare provider if you notice any persistent or bothersome side effects after wearing the patch.

How Can I Stay Healthy While Taking Neupro?

Parkinson's disease is a chronic condition that begins slowly but worsens over time. Taking your medication as prescribed is the best strategy for managing symptoms. However, coping with Parkinson's disease can be more than physical; the condition can also have emotional and social impacts.

If you are experiencing anxiety or depression due to your condition, don't hesitate to reach out to a healthcare provider or therapist for help. They can help you better understand these feelings and provide coping strategies for moving forward.

Additionally, keep in communication with your healthcare provider about your symptom control. Tell them if you feel your medication isn't working well enough or if you are experiencing any new or bothersome side effects. Often, they can adjust your treatment regimen.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. Neupro label.

  2. Raeder V, Boura I, Leta V, et al. Rotigotine transdermal patch for motor and non-motor Parkinson's disease: a review of 12 years' clinical experience. CNS Drugs. 2021;35(2):215-231. doi:10.1007/s40263-020-00788-4

  3. Yeung EYH, Cavanna AE. Sleep attacks in patients with Parkinson's disease on dopaminergic medications: a systematic review. Mov Disord Clin Pract. 2014;1(4):307-316. doi:10.1002/mdc3.12063

  4. Prescribers' Digital Reference. Rotigotine - drug summary.

  5. Food and Drug Administration. Gocovri label.

  6. DailyMed. Label: Apokyn- apomorphine hydrochloride injection.

  7. DailyMed. Label: Miraprex ER- pramipexole dihydrochloride tablet, extended release.

  8. DailyMed. Label: Ropinirole tablet, film coated.

By Queen Buyalos, PharmD
Queen Buyalos is a pharmacist and freelance medical writer. She takes pride in advocating for cancer prevention, overall health, and mental health education. Queen enjoys counseling and educating patients about drug therapy and translating complex ideas into simple language.